Adopting the "product line" focus in subacute.

This will help your facility develop subacute expertise and market it

Able to offer needed patient care services to hospitals in a more cost-efficient setting, and desiring to diversify their own payer and patient mixes, nursing homes across the United States are expanding services into subacute care. However, with the increased competition, not all subacute care programs will be successful. Development of a strong subacute program requires assessment of the market and development of a defined referral base by product line.

Few nursing homes take the time and initiative to develop strong referral bases. However, referrals are critical to the success of a subacute care program. Significant efforts must be expended by the nursing home provider to educate the medical community, discharge planners and insurance carriers as to the benefits and functional outcomes of subacute care, and to ensure that appropriate patient referrals and transfers are generated consistent with the market potential.

Subacute care is and must be marketed as an essential component of the continuum of care. A patient should be able to transition from the most restrictive to the least restrictive care mode of delivery in an expeditious and cost-effective manner.

Timeliness and appropriateness of the referrals to subacute care is dependent upon three primary factors:

1. medical stability of the patient,

2. functional capacity of the patient, and

3. knowledge and familiarity of medical and nursing staff with the purpose and outcome expectations per level of care delivery.

Developing Subacute by Product Line

One of the greatest vulnerabilities nursing homes face in establishing referral sources is lack of credibility as a provider of medically-oriented services. In order to dispel any such concerns, a nursing home should develop its subacute programs under strong medical leadership and with a defined program-oriented focus. Additionally, marketing and education of potential referral sources, including area physicians, third-party payers, case managers and discharge planners, will be of paramount importance.

Critical to developing a strong referral pipeline is development of the subacute care program by specialized product lines. By targeting patient populations by product lines, appropriate referral sources should become apparent. The identification of product lines is critical to the success of a subacute care program. The product line approach serves as the nucleus of management, marketing and financial stability, while providing an effective tool in communicating the facility's subacute care specialization to the general, medical and insurance communities.

Nursing homes providing subacute care can generally develop a product line approach within one or more of the following groupings of specialized services: medically complex; rehabilitation; respiratory care.

Medically Complex. Within the medically complex product line, chronic or seriously ill patients are treated for a variety of disorders, e.g., post-surgical, diabetes, digestive disorders and chronic and other diseases or infections requiring long recovery periods. Cardiac monitoring, wound care and ostomy care can also be provided.

Also within this product line would be patients recovering from organ transplants, heart surgery, plastic, orthopedic, gynecological and urological surgery, general surgery, appendectomies, and gallstone removals. Patients requiring short-term post op transitional care and education on management of lifestyle changes are also included in this group.

Subacute Rehabilitation. These are services delivered to individuals who generally are either too medically frail or as yet do not exhibit sufficient potential to appropriately be admitted to a comprehensive inpatient rehabilitation program. Even some eligible patients may prefer the subacute venue for convenience or location. Additionally, patients who may need less comprehensive rehabilitative therapy may be served through this product line.

The majority of these patients will have diagnoses generally associated with rehabilitation, such as stroke, orthopedic procedures (including joint replacements), general and degenerative neurological disorders (including multiple sclerosis, muscular dystrophy, Parkinson's disease, ALS), amputations, severe arthritis, neuromuscular disorders, and general debilitation. Therapeutic services offered to these patients may include physical therapy, occupational therapy, speech/language pathology, psychology and social services.

The goal of this product line is to optimize patients' functional independence for transition to an outpatient rehabilitation program or a comprehensive inpatient rehabilitation program, if so indicated. Patients requiring a coordinated rehabilitation regimen of moderate intensity are appropriate for this level of care. Approximately 80% of all subacute rehabilitation patients are typically discharged to home within four weeks of admission. Private pay sources (i.e. commercial insurance) should normally account for approximately 35-50% of sub-acute rehabilitation patients.

Patients in this product line may require diagnostic services, including pulse oximetry, arterial blood gases and other laboratory testing, x-rays and cardiopulmonary status monitoring. Therapeutic services available to these patients may include ventilator support and weaning, airway management, and aerosol and oxygen administration. The average length of stay for patients in this type of product line is generally approximately 30-35 days, except patients requiring ventilator support, whose lengths of stay may extend to as much as 120 days.

Screening criteria must be strictly enforced to ensure that only short-term patients are admitted. Inappropriate placement of long-term custodial level or chronic patients in a subacute care program will lead to undue financial burdens.

Conclusion

The existence of a subacute care program with readily identifiable product lines and specialized clinical teams will allow the program to attain a sufficient critical mass of patients to have recognized expertise in a particular product line. This will also assist in the facility's marketing efforts by educating referral sources as to the difference between sub-acute care and general custodial nursing home care. With a competently executed program and a responsive market, the nursing home will enjoy a unique competitive edge in this emerging market.

Cherilyn G. Murer, JD, CRA, is president and CEO of the Murer Group, an International consulting firm specializing in post-acute health cure with a special emphasis in subacute cure. She is a certified rehabilitation administrator and former president of the Association of Medical Rehabilitation Administrators. Lyndean Lenhoff Brick, JD, is the senior vice president of the Murer Group and an attorney with Murer and Associates, a national law firm specializing in health cure and hospital law. The Murer Group is based in Joliet, IL, (815) 727-3355.